DESCRIPTION: Researchers in health informatics continue to find new and innovative ways to collect and organize the data created by the health care delivery process. Disparate systems create challenges in data integration, requiring complex work by those trained in health care information sciences. Although integration of systems across an enterprise can be challenging, the benefit of converting voluminous amounts of data into useful information is tremendous. This information can then be used to provide decision support tools that improve the effectiveness of managers and leaders across the spectrum of care. Emergency department (ED) crowding has become an important issue that plagues many hospitals across the country. ED crowding has been shown to diminish patient and staff satisfaction, and likely undermines the quality of patient care. Hospitals throughout the country are aggressively searching for operational strategies to cope with ED crowding. One of the biggest obstacles for these quality improvement efforts is a lack of timely, accurate, and useful operations data. In the work outlined in this career development proposal, we will use data derived from clinical operations to improve the quality and efficiency of health care delivery in the ED setting. To achieve this, we will first perform an analysis of the information needs of those managing health care operations and construct a data warehouse of ED operations data. Second, using this operations data structure, an iterative survey process will be used to optimally design a real-time digital display of operations information, referred to as an ED Operations Dashboard. Finally, using these developed tools, a numeric measure of ED crowding will be calculated in real-time and used to trigger a high-census alert at times of significant ED crowding. A statistical analysis of the resulting levels of crowding will be performed to determine the effect of an objectively triggered high-census alert.